1. Defining, Assessing, and Fixing the Learning Environment
Larry D. Gruppen, PhD
University of Michigan Medical School

2. Objectives Defining the learning environment: framing theory
Measuring the learning environment: beyond learner perceptions
Changing the learning environment: UME, GME, CPD

3. Getting Started
Where is the learning environment at (The) OSU positive?
Where are there problems with the learning environment?
What are you including in the “learning environment?”

4. Learning Environment Components
Physical facilities
Class size
The faculty
Relationships with peers
Teacher competence
Group size
Patient population
Leisure time
Curricular interventions
Grading systems
Institutional culture
Assessment methods and frequency
Clinic settings
What ISN’T part of the learning environment?

5. Synonyms and Related Terms
Educational climate, social environment, psychological climate, work environment
Context
Context as a target of learning, e.g., understanding the patient’s psychosocial context, the context students learn about, part of the curriculum
Context as influence on learning, the context students learn in, non-curricular, learning environment

6. Curriculum vs. LE Intentional Unintentional Content of learning
Official curriculum
Hidden curriculum
Context of learning
Official learning environment
Hidden learning environment

7. Theoretical Lenses
Surprisingly few, particularly as applied to medical education
There is little theory about the LE in medical education (a not much in higher education, either). Such as it is largely descriptive: here is an aspect of the learning environment and here is what happened
e.g., p/f grading and student perceptions of less competition among peers
e.g., complaints of mistreatment and a search for causes

8. Guiding Frameworks: Moos (1974)
Personal development/goal direction
Educational goals, relevant content, constructive criticism
Relationships
Learner and faculty communication, support, affiliation
System maintenance and system change
Clear expectation, orderly, innovative and responsive

9. Guiding Frameworks: Genn (2001)
Faculty
Students
Administration
Physical features

10. Guiding Frameworks: Miller (1978)
Levels of living systems
Society
Organization
Group
Person

11. Guiding Frameworks: Miller (1978)
Levels of living systems
Society
Organization
Group
Person

12. Guiding Frameworks: Gruppen, Irby, Maggio, Durning (2018)
Sociocultural Dimension
Organization (sociology)
Group (social psychology)
Person (psychology)
Spatial Dimension
Physical environment and learning affordances
Technology Dimension
Virtual learning spaces

13. LE at the Person Level
Personality (intro/extraversion, cooperation/competition)
Prior life and academic experiences
Expectations, goals
Stress levels, resilience

14. Person Level Personality (intro/extraversion, cooperation/competition)
Prior life and academic experiences
Expectations, goals
Stress levels, resilience

15. Group Level
Peer interactions: formal and informal, teamwork, competition, respect
Learner-faculty interactions: feedback, evaluation, mentoring, role-modeling
Learner-patient: autonomy, scaffolding, role in care team
Inter-professional interactions: care teams, inter-professional education

16. Group Level
Peer interactions: formal and informal, teamwork, competition, respect
Learner-faculty interactions: feedback, evaluation, mentoring, role-modeling
Learner-patient: autonomy, scaffolding, role in care team
Inter-professional interactions: care teams, inter-professional education

17. Organization Level
Physical environment: learning spaces, access, learning resources
Clinical setting: learner-specific spaces, meeting spaces, electronic health record implementation
Institutional culture: public vs. private, primary care vs research intensive, for-profit vs non-profit, institutional values and priorities

18. Organization Level
Physical environment: learning spaces, access, learning resources
Clinical setting: learner-specific spaces, meeting spaces, electronic health record implementation
Institutional culture: public vs. private, primary care vs research intensive, for-profit vs non-profit, institutional values and priorities

19. Spatial Dimension Personal spaces Meeting spaces Institutional spaces
Privacy, lighting, storage, familiarity
Meeting spaces
Size, location, accessibility, furnishings
Institutional spaces
Age, navigation, co-location with colleagues, multi- vs uni-purpose

20. Technology Dimension Online-learning Virtual patients
Technology driven simulation
Learning management systems
Electronic health records

21. Assessing the Learning Environment
Something as complex as the LE can be looked at in various ways
LCME, CLER as assessments at the Organizational level
Most instruments at the person level

22. Measuring the LE Numerous instruments in medical education
Three recent systematic reviews of instruments (Soemantri, et al., 2010; Schönrock-Adema, et al., 2012; Colbert-Getz, et al., 2014)
(Almost) all are questionnaires completed by learners
Learner reports of their personal perceptions -> solipsism?
Differences in target setting and item focus

23. Illustrative Items
My work tasks are relevant to the learning objectives. (O)
I feel I have influence over my learning in this placement. (O)
Supervisors, nursing staff, other allied health professionals and residents work together as a team here (G)
My program director reserves time to supervise/counsel me (G,O)

24. Fixing the LE: Change the Curriculum
Effect of curriculum change on student perceptions of the learning environment. Robins, et al., 1996
Single institution, major curriculum change
Department- to organ-based structure, small groups, case-based, p/f grading, extensive use of SPs, formative feedback, etc.
Found a moderate to large effect size advantage of new over old curriculum LE
What made the difference? Impossible to tell

25. LE and Curriculum Change
LCME mandate to monitor the medical school learning environment
Curriculum change for promoting learning and improving the LE
Curriculum change is complex intervention
No one factor causes change, not all change is intentional

26. Satisfied Faculty
Key factors in work engagement and job motivation of teaching faculty at a university medical center. van den Berg, et al., 2013
National survey of university medical center faculty, engagement in teaching predicted by:
teaching about my own specialty
noticeable appreciation for teaching by my direct superior
teaching small groups
feedback on my teaching performance
freedom to determine what I teach

27. Faculty Development
Faculty as contributors to and recipients of the learning environment
They represent the personal, group, and organizational levels of the environment – often the societal level as well
Faculty development for LE improvement not necessarily the same as faculty development for teaching skills

28. Complex Interactions
Institution and specialty contribute to resident satisfaction with their learning environment and workload. Gruppen, et al., 2015
Large multi-institution, multi-specialty survey of resident satisfaction with learning environment
Institution had greater effects on LE satisfaction than specialty
Individual specialty programs at a given institution contribute independently

29. Reduce Student Mistreatment
AAMC definition and student interpretation
Punitive vs appreciative perspective on LE
One event represents entire LE
Like questionnaires, still student defined

30. Build Learner Community
The social component of the LE
Promote cooperation rather than competition
Promote more interaction with faculty members
Coercive element to participation (e.g., required reflections) may have unintended consequences

31. Space New medical education buildings proliferate
Partially, a recognition that the physical environment matters
Not just architecture, but a value statement
Cannot ignore the Star ‘hidden’ learning spaces: Starbucks, home, private, group